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Overcoming Illness Phobia

Illness phobias most commonly the subject of enquiries to Anxiety Care
are - heart disease, cancer, brain tumour, asbestosis, AIDS and a general, and intense,
fear of dying. Occasionally the diseases feared have been multiple. For example, where
panic symptoms cause dizziness and stomach problems, the fears might be a brain tumour and
stomach cancer. Symptoms of illness phobia include ruminating endlessly about the disease
(or death); avoiding anything in the way of radio, TV, newspaper, or magazine coverage on
the subject; or, very occasionally, obsessively collecting such information. Possibly
repeated bodily examinations - personally and through any medical practitioner who can be
persuaded to carry them out; and constant demands for reassurance that the disease is not
present, from family, friends and doctors.

Illness phobias could be placed nearer obsessional/compulsive disorders
than most other phobias as the accompanying rituals can be as troublesome as any generally
found in OCD, and the ruminations about the illness are like an obsession in many ways.
Very often this phobia is found in people suffering from depression and may fluctuate
according to the level of the depression. Sometimes there are no other symptoms. Research
shows that, when associated with depression, this phobia can be quite short lived, less
than a year in some cases. However there is no reliable data on the duration of illness
phobia where there is no depressive problem. There doesn't seem to be one particular cause
of illness phobia; but people contacting Anxiety Care with the phobia have detailed a
number of similar, associated problems apart from depression. These include a close family
member or friend with, or who had recently died of, the feared illness. A tendency to fear
certain illnesses in their family. Various personal problems such as feeling unwanted, of
little value, being lonely or over protected or extremely self pitying. There have also
been 'practical' aspects such as poor general health or persistent pain. In the case of
pain which tended to 'prove' to the person that there was something wrong, this could have
been imaginary; part of the pains, twinges and gurgles we all experience every day
(illness phobics are extra alert for, and alarmed by, their bodily sensations); some
genetic and harmless quirk of their body; or even a symptom of something else, like an
emotional pain or guilt. Other practical problems have included misunderstanding doctors
comments or silences. This is not hard to understand given that the person is attuned to
the slightest alarm that could be triggered by tone of voice or a look when the dreaded
subject is under discussion, and that they may have consulted this fed-up doctor many
times with the same fear.

Most phobics avoid the dreaded situation or object, escaping quickly
from the stimulation. This instant relief of tension by escape rapidly becomes a habit and
maintains the phobia. Proven successful treatment involves helping sufferers to face the
fear by staying in the feared situation via a personally appropriate desensitisation
programme. Simply, this is fitting as many steps as needed between what the person can do
and wants to be able to do, and working through them, accepting the level of anxiety
generated each time. However, illness phobics cannot avoid their feared stimulation
because most of it - in the form of thoughts and bodily pains - is inside themselves. The
anxiety does not reduce even though this person cannot escape it, and is likely to be more
permanent and so more of a problem. It does not respond well to 'desensitisation'
treatments and alternatives could include psychiatric counselling.

Avoidance with resultant anxiety reduction, that might respond to such
treatment is that involving escaping from discussions or media stories about the illness;
checking that people and objects the person comes in contact with are not 'contaminated'
by the illness; and seeking constant reassurance, from family and doctors, that the person
has not got the feared illness. Steps involving stories might include reading about the
problem, perhaps just a few words at first, working up to full stories. With
contamination, it could include not avoiding utensils such as knives and forks, or being
in the company of people with the illness.

Therapy reported to Anxiety Care for a cancer phobic using this method,
involved the person visiting a cancer ward, shaking hands with and eating with cancer
victims and looking at pictures of cancerous cells; and eventually handling a receptacle
containing cancerous tissue. Steps that can reduce the need for reassurance might involve
teaching the family to respond with set phrases such as "We agreed that I would not
reassure you", or "The hospital has said (or, we agreed) that I must not
reassure you". (Offered kindly but unemotionally, never with anger). This can
sometimes be very difficult, as the family concerned is likely to care deeply for the
sufferer and the person will be aware of the best ways to obtain such reassurance from
them, using this caring. In this case, those concerned might have to role-play asking for
and refusing reassurance until the pattern is established, which might take a number of
sessions. Or they could do this under the supervision of a professional such as a clinical
psychologist or psychiatrist. GPs and other non-psychiatric professionals who are closely
involved with the sufferer, might also have to learn to refuse reassurance in this way.

The basic reference work on which we have drawn is Fears, Phobias and
Rituals by Professor I M Marks, published by Oxford University Press (1987)